Patients plagued by crippling migraine are being cured by operations on the HEART

For 40 years, Janis Watson’s life was dominated by painful and debilitating migraines.

The problem - which started when she was 11 - had become so bad that the 55-year-old nurse was lucky if she had two or three days a week without an excruciating headache.

The migraines also caused vomiting and vision problems such as flashing lights and zigzag patterns in front of her eyes, numbness to her face and jumbled speech.

New ideas: Some doctors believe migraines with aura are linked to a hole in the heart and can be cured by an operation

‘My migraines were so severe that I had no choice but to go to bed in a darkened room and wait for it to pass, which could take up to six days,’ she says.

‘The pain was excruciating. I wanted to bang my head on the wall to
relieve it. At times, it was like having a mini-stroke, as my face
would go numb and my speech become slurred.’

‘Certain foods would trigger the attacks - poultry, liquorice,
grapes, peppermint-flavoured chocolate and alcohol,’ says Janis, from
Denby, Derbyshire. ‘I would also get a migraine if I was really tired.’

On one occasion, Janis had to be admitted to hospital for four days after she became so disoriented by the pain.

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The neurological condition can be treated with medication - there are tablets to prevent migraines and others that can be taken at the time of the attack. But for many sufferers such as Janis, these pills have a limited effect.

Surprise cause

For years, it was thought that migraines were caused by a change in the level of blood flow to part of the brain. However, some doctors now believe that migraines with aura (sensitivity to light and sound, and speech problems), which affect nearly a fifth of all sufferers, are strongly linked to a common heart defect - a small hole in the heart.

This hole - a flap-like opening between the upper chambers of the heart - is essential for a baby in the womb, but should close after birth. (A baby in the womb does not use its lungs to breathe, as it gets oxygenated blood from its mother. The hole allows this blood to bypass the lungs.)

In around a quarter of people, this hole never closes, a condition known as a patent foramen ovale (PFO). For the majority of people, it will cause no problems; many are unaware they have the condition.

However, when it remains open, blood in the veins containing small clots or chemicals (because it has not been through the filtering system of the lungs) may pass through the hole into arteries and flow into the brain. These clots and chemicals could be a trigger for migraine with aura. They have also been associated with stroke.

So far, the limited research into migraine and PFO has failed to provide scientific evidence but a new study, at South Manchester University Hospital and other Europe and Canadian hospitals, hopes to provide this evidence.

Doctors first suggested that closing a PFO could reduce or prevent migraines after a study published in medical journal The Lancet in 2000.

This found patients who had the operation done for other reasons (such as after a stroke) reported they were no longer suffering from migraines. For the past five years, the procedure has been available to aid migraine, but only for medical trials.

To close the hole, doctors insert a tube with the closure device into a vein in the groin and guide it up to the heart using X-ray monitoring. It is then passed through the hole and, when in the right position, the device is released and two folded umbrellas within it open up to plug the gap.

The 30-minute procedure is done under a general anaesthetic, but patients normally go home the next day. They take blood thinning tablets for a few months.

‘The device is a foreign body in the heart and the natural reaction is for blood clots to form on it,’ explains Dr Rockesh Gurtu, a research fellow at Wythanshawe Hospital, Manchester, who is involved in the new trial.

‘Blood thinning tablets prevent clots forming around the device. Six months later, the device won’t be exposed any more, as it will be encased by the body’s tissue.’

The aim of this new trial is to test definitively that migraines can be helped with PFO closure.

Transformed

Four years ago, Janis Watson was one of the first patients to have this treatment. She’d discovered she had a hole in her heart after taking part in another scientific study, so desperate was she for a cure.

To see if she had a hole in her heart, doctors carried out an ultrasound. ‘When I was told I did, I was elated. It sounds silly, but I was pleased there was something that might be causing the migraines. This meant, hopefully, something could be done.’

For Janis, the operation - carried out as part of a trial at the Queen Elizabeth Hospital, Birmingham - has transformed her life. She now gets only a much shorter migraine every seven or eight months.

She has been to the U.S. on holiday for the first time and has introduced some of the foods which triggered migraines back into her diet.

One explanation for the treatment’s success is that if migraines are caused by chemicals getting to the brain, these chemicals exist in a much lower concentration once the hole is closed and blood is filtered by the lungs.

‘This is all speculationat the moment,’ adds Dr Gurtu. ‘For some people the procedure has worked and for others it hasn’t - we still need to determine all the factors that cause migraine.’

David Ratcliffe, 41, a GP, from Manchester, has also suffered from migraines.

He, too, has seen an improvement since having the hole in his heart closed in 2007, after he took part in a different study.

‘Before, when I had a migraine, I’d lose my vision for up to an hour. I would have to explain to patients why I had to delay a surgery, as I couldn’t see to write a prescription,’ he explains. ‘Since the operation I’ve not had a migraine - before, I would have one every couple of months.’

However, while these stories are encouraging, Susan Haydon, of The Migraine Trust, says: ‘On the evidence so far, the risks of closing a hole in the heart to treat migraine outweigh the benefits.

‘Closing a large hole in the heart makes sense, for example, to try and prevent stroke. However, cardiac surgery under general anaesthetic cannot be justified, and would not be offered, for the treatment of migraine unless it was part of a clinical trial.’

But there is hope that the new study, known as PRIMA, which is currently recruiting, will help to provide answers about the condition.

Lee Tomkins, director at Migraine Action, says: ‘We hope any further clinical research into this procedure might give us clues to see if it has a long-term future as an alternative treatment for migraine.’

However, for people like Janis there is no doubt in her mind that the operation was the key to controlling her migraines. ‘I am convinced the closure of the PFO was the solution. It’s one of the best decisions I’ve ever made,’ she says.

• To join the trial, you must be aged 18-65; have experienced your first migraine before you were 50; have a migraine between five and 14 days a month, and have experienced aura problems such as blurred vision and difficulty speaking. For further details, phone free on 0808 238 9153.

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Patients plagued by crippling migraines are having them cured by operations on the HEART